tbuckley/cabot-search huggingface dataset:
Abstract 11668: Trends in Statin Use for Primary Prevention by Race/Ethnicity and ASCVD Risk in the US: 2013-2020
Authors: Joshua A Jacobs, Daniel K Addo, Alexander R Zheutlin, Catherine G Derington, Utibe R Essien, Ann M Navar, Inmaculada Hernandez, Donald M Lloyd-Jones, Jordan B King, Shreya Rao, Jennifer S Herrick, Adam P Bress, Ambarish Pandey
Journal: Circulation (2022)

Introduction: The burden of ASCVD is higher among non-Hispanic Black (NHB) and Hispanic vs. non-Hispanic White (NHW) US adults, potentially due to differences in use of preventive medications such as statins. We evaluated patterns in statin use for primary prevention by self-identified race/ethnicity (NHB, NHW, and Hispanic) according to 10-year ASCVD risk using the Pooled Cohort Equations. Methods: This serial, cross-sectional analysis included NHANES participants from 2013-2020 age 40-75 years without ASCVD, diabetes, LDL ≥190 mg/dL, or missing data for estimation of 10-year ASCVD risk. Statin use was determined by interviewer pill bottle review. Poisson regression estimated adjusted prevalence ratios for statin use associated with race/ethnicity and ASCVD risk categories (5-&lt;7.5%, 7.5-&lt;20%, and ≥20%); all analyses incorporated NHANES survey weights. Results: A total of 3,088 participants representing 37.8 million US adults (mean age 62 y, 38% women, 13% NHB, 11% Hispanic, 76% NHW) were included. Overall, statin use was lower in NHB (20.0%) and Hispanic (15.4%) than NHW adults (27.9%). Within all ASCVD risk categories, the odds of statin use were significantly lower among NHB and Hispanic vs. NHW adults (Figure). Within each race/ethnicity group, the use of statins increased across increasing ASCVD risk strata, with a significantly greater utilization among those with ASCVD risk ≥20% (vs. ASCVD risk 5-&lt;7.5%) (Figure). Statin use was stable over time and within race/ethnicity and risk strata (p&gt;0.05 for all NHANES cycles). Conclusions: Overall statin use for primary prevention based on 10-year ASCVD risk was low in all race/ethnicity groups regardless of predicted ASCVD risk, though undertreatment was most severe in NHB and Hispanic adults. Improvements in equitable utilization of statins for primary prevention in Black and Hispanic adults are needed to address disparities in ASCVD.
Abstract 12001: An Unusual Case of Necrotizing Acute Pericarditis
Authors: Sasha Sharifi, Anjula Chib, Vivek Menon, likhitesh jaikumar, Paul Volansky, MANDAR JAGTAP DO, Tara George, Sophia Thang, Christopher Smith
Journal: Circulation (2022)

BACKGROUND: Acute pericarditis is the most common disorder affecting the pericardium. It accounts for less than 1% of patients who are admitted to the hospital for non-ischemic chest pain and 5% who present to the emergency department with non-ischemic chest pain. The most common etiology of acute pericarditis in developed countries is idiopathic although a pre-disposing viral illness has also been recognized as a common cause. Infectious etiologies in developed countries have been seen with commonly occurring viruses such as coxsackievirus, echovirus, adenovirus and less frequently EBV. CASE: We present a 41-year-old man who came in with fevers, rigors, shortness of breath and chest pain. Transthoracic echocardiogram was (TTE) demonstrated a large pericardial effusion without evidence of tamponade. He underwent a diagnostic pericardiocentesis followed by a pericardial window during his initial hospitalization without any complications and was discharged home on NSAIDs and colchicine. Serology results demonstrated positive EBV IgG and Nuclear Antigen, concerning for active EBV pericarditis. Pathology resulted as necrotizing pericardial tissue with diffuse inflammation. The patient was readmitted within 48 hours with worsening shortness of breath and leg edema. Repeat TTE revealed a large recurrent pericardial effusion with right ventricular collapse concerning for tamponade. The patient was ultimately transferred to a tertiary care center for pericardiectomy evaluation. DISCUSSION: Ebstein-Barr virus is rarely an etiology of acute pericarditis, much less necrotizing pericarditis. When identified it should raise concern for long term complications such as recurrent pericarditis and tamponade. We believe patients who have evidence of necrotizing pericarditis are at a high risk for constrictive pericarditis and should not only have closer follow while maintaining a low clinical threshold for definitive treatment with pericardiectomy.
Abstract 12598: Effect of Mavacamten on Systolic Anterior Motion of the Mitral Valve and Mitral Regurgitation in Patients With Obstructive Hypertrophic Cardiomyopathy: Insights From the VALOR-HCM Study
Authors: Paul C Cremer, Jeffrey B Geske, Anjali T Owens, Wael A Jaber, Serge C Harb, Sara Saberi, Andrew Wang, Srihari S Naidu, Hartzell V Schaff, Nicholas G Smedira, Quing Wang, Kathy Lampl, Amy J Sehnert, Steven E Nissen, Milind Y Desai
Journal: Circulation (2022)

Introduction: In the randomized VALOR-HCM study of symptomatic patients with obstructive hypertrophic cardiomyopathy (oHCM), mavacamten reduced the need for septal reduction therapy at 16 weeks. The current sub-study sought to assess the impact of mavacamten on systolic anterior motion (SAM) of the mitral valve and associated mitral regurgitation (MR). Methods: Patients on maximally-tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. Echocardiographic assessment was performed by an independent, blinded core laboratory. SAM was assessed as none, mild (anterior leaflet &gt;/= 1 cm from the septum), moderate (anterior leaflets &lt;1cm from the septum), and severe (anterior leaflet in contact with septum). MR was assessed according to ASE guidelines. Results: Among 112 enrolled patients, 23.2% (n=27) had at least moderate (2+) MR. Most (92.9%, n=104) had at least moderate resting SAM, of whom 55.4% (n = 62) had severe SAM. At 16 weeks, 53.7% of patients treated with mavacamten had at least one level improvement in resting SAM compared to 21.6% of patients treated with placebo ( p = 0.001), and 35.2% had at least a two level improvement in SAM compared with 11.8% of placebo patients ( p = 0.007)(Figure 1A). Similarly, patients treated with mavacamten had an improvement of -36.0 + 28.8 mmHg in resting left ventricular outflow tract gradient at week 16 compared to -1.5 + 26.5 mmHg with placebo (&lt;0.001). At week 16, 48.1% of patients treated with mavacamten had at least a one grade improvement in MR, and 23.1% had at least a two grade improvement compared to 12.2% and 6.1% of patients treated with placebo ( p &lt;0.001 and 0.025, respectively)(Figure 1B). Conclusions: In highly symptomatic patients with oHCM, treatment with mavacamten reduced resting SAM with an improvement in associated MR.
Abstract 12386: The Prevalence of Coronary Microvascular Dysfunction Among Patients With Low Pretest Probability of Coronary Artery Disease
Authors: Ahmed H Aljizeeri, Amjad M Ahmed, Mohammed Zayed, Mousa AlaliAlfaris, AWADELKARIM ABDALLA ELNEAMA, Ihab Suliman, Mohsen Al Harthi, Ahmed A Alsaileek, Mouaz Al-Mallah
Journal: Circulation (2022)

Introduction: Coronary microvascular dysfunction (CMD) is an underdiagnosed cause of chest pain. The 2021 AHA/ACC guidelines do not advocate for testing in patients with chest pain and low pretest probability (PTP &lt;15%) of coronary artery disease (CAD). The prevalence of CMD among patients with low pretest probability is not known. We sought to estimate the prevalence of CMD among patients with chest pain and a low pretest probability of CAD. Methods: We reviewed all the patients referred to positron emission tomography myocardial perfusion imaging (PET-MPI) from May 2011 to January 2022. Patients with chest pain and low PTP of CAD who had normal PET-MPI were included in the analysis. Rest and peak myocardial blood flows (MBF) were measured. Coronary flow reserve (CFR) was calculated as a ratio of peak/rest MBF. CMD was defined as CFR of &lt;2. Results: 1873 patients (age 53.7 ± 9.3 years, 23.6% males) with low PTP and normal PET-MPI were included in the analysis. 372 (20%) patients had MVD. Patients with CMD had lower use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, aspirin, and statin. Diabetes, hypercholesterolemia, and hypertension did not predict CMD. However, female gender (OR: 1.7 95%CI: 1.1- 2.6, p=0.016), age (OR: 1.02 95%CI: 1.00 - 1.04, p=0.023) and BMI (OR: 1.04 95%CI: 1.02 - 1.07, p=0.001) were associated with higher likelihood of MVD. Conclusions: Coronary Microvascular Dysfunction is common among patients with chest pain, low PTP of CAD, and normal myocardial perfusion imaging. Females are more likely to have CMD. Further studies are needed to verify the prognostic value of this population.
Abstract 12458: Limb and Cardiovascular Events at 6 Months Among CLTI Patients Receiving Routine Care at BEST-CLI Sites: An Interim Report From the BEST-Registry
Authors: Hope Weissler, Manesh R Patel, Nishant Shah, Abigail Patterson, Jennifer A Rymer, Matthew MENARD, Laura A Drew, Daniel B Mark, Carlos Mena-Hurtado, Benjamin Brooke, Robert Molnar, Mohamed Zayed, Samir Shah, Vikram S Kashyap, Joshua Beckman, Igor Laskowski, Kenneth Rosenfield, Alik FARBER, Sreekanth Vemulapalli
Journal: Circulation (2022)

Introduction: Chronic limb-threatening ischemia (CLTI) affects 1-2 million Americans yet remains understudied. Existing CLTI trials focus on endovascular procedures and surgeries, maintain strict inclusion criteria, and may not fully capture the breadth of the CLTI population. We aimed to build a robust understanding of current treatments, outcomes, quality of life, and healthcare utilization among a diverse cohort of CLTI patients from across the United States. Methods: Designed as a companion to the BEST-CLI randomized trial, the BEST-Registry will prospectively enroll &gt;1,000 CLTI patients at 40 U.S. BEST-CLI sites and follow their clinical courses for 12 months. Though initially, only patients ineligible for BEST-CLI were to be enrolled, BEST-Registry enrollment did not begin until after BEST-CLI enrollment ended. Baseline data including demographics, medications, and available hemodynamic data are collected as well as wound care regimens, interventions, and quality of life (VASCUQOL-6, EQ-5D, and SF-12). The primary adjudicated endpoint is major adverse limb events (MALE) defined as above-ankle amputation or major revascularization. Secondary endpoints include mortality, hospitalizations, MALE-free survival, and quality of life. Results: We will present 6-month adjudicated outcomes of 534 participants. The median age is 70.0 years [IQR 62.0, 77.0] and 35% are female ( Table ). Documented rates of hypertension (89%), diabetes (67%) and hyperlipidemia (78%) are high at baseline. Only 46.6% of patients had hemoglobin A1c and 38.8% LDL-c lab values available within a year. However, control of these two lab values was relatively good ( Table ). Conclusions: Patients with CLTI enrolled in the BEST-Registry are diverse, have complex disease, many comorbidities, and receive a variety of treatments. Registry data at 6 and 12 months will provide important context for the BEST-CLI trial results and characterize contemporary management and outcomes in CLTI.
Abstract 12431: Association of Obesity With Incident Atrial Fibrillation in Korea and the United Kingdom
Authors: Sung Hwa Choi, Pil-sung Yang, Daehoon Kim, Jung-Hoon Sung, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Hui-Nam Pak, Moon Hyoung LEE, Gregory Y.H. Lip, BOYOUNG JOUNG
Journal: Circulation (2022)

Introduction: Obesity has been linked to atrial fibrillation (AF) burden and severity, and epidemiological studies suggest that AF is more prevalent in whites than Asian or Afro-Caribbean populations. We aimed to investigate whether obesity mediates associations with AF in Europe and Asia using patient-level data comparisons of two cohort studies. Hypothesis: We therefore hypothesized that the difference in the distribution of BMI and WC can partially explain the ethnic differences in AF incidence Methods: Using Korean National Health Insurance Service’s Health Screening (NHIS-HealS) and U.K. Biobank data, we included 401,206 Korean and 477,926 British aged 40-70 years without previous AF who received check-ups. The incidence and risk of AF were evaluated regarding different body mass index (BMI) values. Results: The obese proportion(BMI ≥ 30.0 kg/m 2 , 2.8% vs. 24.3%, P &lt; 0.001) was higher in the U.K. than the Korean. In the Korean and U.K. cohort, the age- and sex-adjusted incidence rates of AF were 3.52 and 3.95 per 1,000 person-years among overweight individuals (BMI, 25 to &lt;30 kg/m 2 ), and 4.97 and 6.54 per 1,000 person-years among obese individuals, respectively. Compared to Koreans, the risk of AF was higher in the British population, with adjusted hazard ratios of 1.11 (95% confidence interval [CI], 1.04-1.19) and 1.16 (95% CI, 1.11-1.22) in overweight participants and 1.69 (95% CI, 1.57-1.83) and 1.45 (95% CI, 1.30-1.62) in obese participants, respectively ( P for interaction &lt; 0.05). Conclusions: Obesity was associated with AF in both populations. British subjects had a greater incidence of AF related to the high proportion of obese individuals, but the risk of AF was also increased when separating participants into overweight and obese categories.
Abstract 11040: Disparities in Inpatient Intensity of End-of-Life Care for Children With Advanced Heart Disease
Authors: Spenser Y Chen, lisa chamberlain, Olga Saynina, Susan M Fernandes, Emily E Johnston
Journal: Circulation (2022)

Introduction: Children dying of advanced heart disease experience high intensity end-of-life care (EOLC). However, little is known about disparities in EOLC intensity, which is critical for EOLC equity. Methods: We conducted a population-based retrospective analysis using the California Office of Statewide Health Planning and Development private inpatient discharge database to assess disparities in inpatient EOLC intensity by examining the terminal admission for children (0-21y) with cardiomyopathy and moderate/complex congenital heart disease (CHD) who died in 2005-2018. We examined rates of medical intensity (intubation, CPR, etc.) and cardiac intensity (ECMO, ventricular assist device interventions, other cardiac surgeries, or ≥ 2 cardiac catheterization, biopsy, or electrophysiology procedures). Clinical and sociodemographic factors, including death at a California Children’s Services designated cardiac special care center, associated with medical intensity and cardiac intensity were examined. Results: The 2,794 children died and 76% were &lt; 1 year old. Of them, 26% had cardiomyopathy, 44% moderate CHD, and 46% complex CHD. The majority were male (55%) and publicly insured (64%). The largest racial/ethnic group was Hispanic (50%) followed by non-Hispanic white (26%). Mean length of terminal admission was 31±50d, and 82% died at a cardiac special care center. During the terminal admission, the majority (79%) were intubated, 39% had cardiac surgery, 30% received ECMO, 28% received CPR, and 42% had a cardiac intensity marker. Black children and children with cardiomyopathy were less likely to have a cardiac intensity marker (aOR=0.6 [95% CI: 0.39-0.91]; reference, non-Hispanic white, aOR=0.46 [95% CI: 0.34-0.61]; reference, moderate CHD, respectively). Children who died at a cardiac special care center were more likely to have a cardiac intensity marker (aOR=6.79 [95% CI: 4.95-9.32]; reference, non-specialty center). Conclusion: Children with advanced heart disease in California exhibited high intensity EOLC with significant sociodemographic variation. It is critical to determine if this variation represents patient preferences, provider biases, or systemic factors such as resource availability.
Abstract 11100: Persistent Gender Disparities in STEMI Mortality: Insights From the Midwest STEMI Consortium
Authors: Divya Kompella, Mehmet Yildiz, Brynn Okeson, Kirtan Patel, Dalia Aziz, Madison Pico, Ross Garberich, James Jollis, Jenny Chambers, Frank Aguirre, Santiago A Garcia, Scott W Sharkey, Timothy D Henry, Odayme Quesada
Journal: Circulation (2022)

Introduction: Over the past two decades, national and regional initiatives have been dedicated to closing the gender gap and resolving disparities in STEMI care and outcomes for females. In this study, we explored how gender disparities have evolved in a well-established regional STEMI system in the US. Methods: Using the Midwest STEMI Consortium database, we examined sex differences in STEMI treatment and outcomes when stratified by decade from 2003 to 2009 versus 2010 to 2020. Results: Among 12,878 consecutive STEMI patients, 30.3% were female. Females were older and more likely to have a history of hypertension and diabetes as compared to males in both time periods (2003-2009 and 2010-2020). Females persistently had longer door-to-balloon times, underwent less revascularization with PCI, and received GDMT less often than males in both time periods. From 2003 to 2009, the incidence of cardiogenic shock was higher in females. Despite improvements in the rate of in-hospital mortality in the last decade, the post-discharge to 1-year mortality risk was significantly higher in females compared to males in both time periods. Conclusions: Over the past two decades, gender disparities in STEMI care and outcomes have persisted. Despite an improvement in the rate of in-hospital mortality, sex differences persist with females having a higher risk of discharge to 1-year mortality. This is in part due to persistent discrepancies in baseline comorbidities and patient care, including longer door-to-balloon times and less GDMT at discharge. These findings underscore the need for both regional and national efforts to close this persistent gap.
Abstract 12407: Hypothalamic-Pituitary Adrenal Axis Activation in Women With Takotsubo Syndrome
Authors: Elena Salmoirago-Blotcher, Janice Tripolone, Christopher Breault, Jerrold Meyer, Emily Gathright, J Dawn Abbott, Adam Saltzman, Junyang Lou, Matthew Burg
Journal: Circulation (2022)

Introduction. Takotsubo Syndrome (TS) has been associated with acute stress exposure and excessive activation of the adrenergic nervous system. Less is known about the role of chronic stress and of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of TS. Hair cortisol concentration (HCC) is a novel biomarker of chronic stress and HPA axis activation. Plasma cortisol is incorporated in growing hair (average growth rate = 1 cm/month), reflecting HPA axis activity over the preceding months. In this study we measured HCC in TS patients and explored associations between HCC, trigger status, and psychological characteristics at enrollment. Methods. HCC was measured in a group of patients admitted with a new TS diagnosis based on Mayo Clinic criteria (n=18). Demographics, perceived stress, depression, anxiety, PTSD symptoms, coping skills, and resilience (self-report questionnaires); trigger history (standardized in-person interview); and HCC were collected at the baseline visit. Hair strands were cut near the scalp from a posterior vertex position. HCC was measured in the first 3 cm of hair, which reflects plasma cortisol levels during the previous 3 months. Samples were washed, ground, extracted in HPLC-grade methanol, and quantified (pg/mg) using a high-sensitivity enzyme immunoassay (EIA) kit. Descriptive statistics were used to characterize the sample, and Spearman rho to examine associations. A p value (2-sided) &lt; .05 was considered significant. Results. Participants were 65.6 (SD 9.4) years old, 100% female, 100% white, 10% Hispanic. 52% married/living as married. Median HCC was 6.35 pg/mg (IQR 3.6, 15.2). HCC was significantly higher in patients reporting no triggers vs. those reporting a trigger prior to the TS episode (14.9 vs. 6.8 pg/ml, p=0.03). No associations were found between psychological measures and HCC, except for a non-significant inverse association between HCC and PTSD symptoms (rho=-0.35; p=0.14). Conclusions. This first exploration of HCC levels in patients with a recent TS episode suggests that chronic HPA axis activation likely does not play a role in the pathophysiology of TS. Findings need to be confirmed in a controlled study with a larger and more diverse sample.
Abstract 12624: Smooth Muscle Cell Alpha-Actin Pathogenic Variant That Predisposes to Moyamoya-Like Cerebrovascular Disease Alters Smooth Muscle Cell Phenotype and Metabolism
Authors: Anita Kaw, TING WU, Albert J Pedroza, Abhijnan Chattopadhyay, Dongchuan Guo, Kaveeta Kaw, Zhen Zhou, Michael P Fischbein, Ketan Ghaghada, Sean P Marrelli, Callie Kwartler, Dianna M Milewicz
Journal: Circulation (2022)

Pathogenic variants in ACTA2 , which encodes smooth muscle α-actin ( α-SMA ), predispose to thoracic aortic disease. ACTA2 variants disrupting arginine 179 ( R179 ) also predispose to moyamoya-like ( MMD ) cerebrovascular disease, characterized by occlusion of the distal internal carotid arteries by neointimal cells that stain positive for smooth muscle cell ( SMC ) markers. Mice with conditional knockin of the Acta2 R179C mutation specifically in SMCs were generated ( Acta2 SMC-R179C/+ ). RNA sequencing and 2D gel electrophoresis confirmed presence of the mutation. Acta2 SMC-R179C/+ SMCs are not fully differentiated, maintain stem cell marker expression, and proliferate and migrate faster than wildtype ( WT ) SMCs. Seahorse analyses show increased glycolysis and decreased oxidative respiration ( OXPHOS ) in Acta2 SMC-R179C/+ SMCs, which have reduced mitochondrial mass and complex I activity, suggestive of deficient electron transport chain activity. Nicotinamide riboside ( NR ) augments complex I activity to boost OXPHOS without altering mitochondrial mass in Acta2 SMC-R179C/+ SMCs. NR also increases differentiation and reduces migration in Acta2 SMC-R179C/+ SMCs. With left carotid artery ligation ( LCAL ), 33% of Acta2 SMC-R179C/+ mice die within 4 days due to strokes, and 100% of surviving Acta2 SMC-R179C/+ mice at postop day 21 have occlusive lesions in the injured artery (8% in WT mice) containing α-SMA+ cells and fibrin deposits. Acta2 SMC-R179C/+ mice also exhibit markedly increased left carotid artery diameter and increased number, diameter, and tortuosity of left-sided collateral vessels compared to WT mice at postop day 21. NR treatment reduces deaths of LCAL-injured Acta2 SMC-R179C/+ mice to 8%, completely resolves occlusive lesion formation in 50% of mutant mice, and attenuates collateral formation and remodeling. These data suggest that immature SMCs with the ACTA2 R179C variant proliferate and migrate into the neointima causing MMD-like occlusive disease. Shifting metabolism to OXPHOS with NR drives differentiation and reduces migration, which diminishes arterial lesions in Acta2 SMC-R179C/+ mice. These data support the use of NR as a therapeutic to prevent MMD-like lesions and ischemic strokes in children with ACTA2 p.R179 variants.